Provider Demographics
NPI:1063288538
Name:MACK, ISABELLE EVA
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:EVA
Last Name:MACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13115 W MISSISSIPPI CT APT 309
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3484
Mailing Address - Country:US
Mailing Address - Phone:650-743-0198
Mailing Address - Fax:
Practice Address - Street 1:13115 W MISSISSIPPI CT APT 309
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3484
Practice Address - Country:US
Practice Address - Phone:650-743-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator